If you’re considering acupuncture but wondering whether your insurance will cover it, you’re not alone. Many patients are unsure how acupuncture benefits work, what’s covered, and how to navigate insurance claims. This guide will answer common questions about using insurance for acupuncture, including coverage eligibility, deductibles, superbills, and tips to maximize your benefits.
Does Insurance Cover Acupuncture?
This is the most common question we get, and we understand why! Having acupuncture coverage can be the difference between seeing a specialist or not, and can help you chose which specialist to see to save money.
Acupuncture insurance coverage varies depending on your health plan. A provider listed as in-network does not necessarily mean that your specific plan covers their services. Some insurance providers include acupuncture under their policies, while others may only cover specific conditions being treated, such as:
• Chronic or low back pain (sometimes related to only a specific area)
• Migraines and headaches
• Postoperative nausea or nausea related to pregnancy
• Osteoarthritis
• Sciatica
To find out if your plan covers acupuncture and if there are limits to what conditions your plan may cover, check your benefits online or call your insurance provider directly. We are currently in-network with Blue Cross Blue Shield of Illinois, Cigna, and Aetna and can verify your insurance coverage before your visit.
How to Check If Your Insurance Covers Acupuncture
1. Log in to Your Insurance Portal or Call Your Insurance Provider – Ask a representative if acupuncture is covered, what conditions are eligible, and whether you need a referral. You can also search “acupuncture” through your online insurance portal.
2. Ask Your Acupuncture Clinic – We offer insurance verification services and can confirm your benefits for you. Click here to complete our insurance verification form to understand your acupuncture coverage.
Understanding Deductibles and Copays for Acupuncture
Even if your insurance covers acupuncture, you may have out-of-pocket costs, such as:
• Deductible: The amount you must pay before insurance starts covering services. If your plan has a $1,000 deductible and you haven’t met it yet, you’ll pay out of pocket until you reach that amount. The trick with a deductible is that you need to understand what in your plan can be paid towards your max number. For example, payments you make for some pharmaceuticals or medical services will NOT count as payments towards your deductible.
If you are paying towards your deductible, you will not be able to use our acupuncture treatment packages, and your payments will be charged per visit.
• Copay: A fixed amount (e.g., $20-$50 per visit) you pay for each acupuncture session. Depending on your plan, these payments might count towards your deductible or not.
• Coinsurance: A percentage of the service cost you must pay after meeting your deductible (e.g., 20% of each session). This is a percentage of the charges which your provider sends to insurance, so that price can vary based on what is being charged each treatment.
What is a Superbill and How Does It Work?
If we are out-of-network for your plan or if you do not have acupuncture coverage, we can provide you with a superbill, which you can send to your insurance provider. A superbill is a detailed invoice that includes:
• Your diagnosis and treatment codes
• Date of service
• Provider information
• Total cost of treatment
To use a superbill:
1. Pay for your acupuncture session upfront
2. Request a superbill from us
3. Submit the superbill to your insurance company
4. Receive reimbursement (if your plan allows it)
Check your out-of-network benefits to see what percentage of the cost your insurance might cover. A superbill is not a guarantee that you will receive reimbursement from your insurance provider, but it might help to reduce your out of pocket medical costs.
Does Medicare or Medicaid Cover Acupuncture?
• Medicare: Covers acupuncture for chronic low back pain under certain conditions, but not for other conditions. We are currently not in-network with Medicare.
• Medicaid: Coverage varies by state. Some Medicaid programs cover acupuncture for pain management, substance use disorders, and other medical conditions. We are currently not in-network with Medicaid.
Tips for Maximizing Your Acupuncture Insurance Benefits
• Verify benefits with your insurance provider before scheduling your first appointment. This prevents unexpected costs. You will receive a link to our insurance eligibility form with confirmation of your new patient appointment.
• Use an in-network provider (if possible) to lower out-of-pocket expenses. We are currently in-network with BCBS IL, Cigna, and Aetna.
• Track your visits to stay within annual session limits. Some plans limit acupuncture visits per year. We can work with you to schedule a treatment plan that would best work with your visit limits.
• Save all superbill receipts for reimbursement or tax deductions.
Find Out if Your Insurance Covers Acupuncture
If you’re unsure about your acupuncture benefits, contact your insurance provider or complete our insurance form here. We can help verify your insurance and explain your options so you can get the care you need. As providers, we can provide general advice relating to coverage for our services. Please contact your insurance provider for answers related to your specific plan and coverage.
